Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

POSHAN District Nutrition Profiles_Guide to DNPs

1,220 views

Published on

POSHAN District Nutrition Profiles (DNPs) draw on diverse sources of data to compile a set of indicators on the state of nutrition and its cross-sectoral determinants. The profiles are intended to be conversation-starters at the district level and to enable discussions about why undernutrition levels are high, and which factors, at multiple levels, might need to be addressed to improve nutrition.

PLEASE NOTE that this guide uses the example of Bihar. POSHAN is regularly tracking data sources as they are released and updating the profiles accordingly.

Published in: Data & Analytics
  • Be the first to comment

  • Be the first to like this

POSHAN District Nutrition Profiles_Guide to DNPs

  1. 1. Shruthi Cyriac, Abhilasha Vaid, Elisa Knebel, Srabashi Ray, Suman Chakrabarti, Parul Tyagi and Purnima Menon District Nutrition Profiles A Quick Guide
  2. 2. BACKGROUND India is land to millions of undernourished children, however, little is known about undernutrition and its multiple determinants at the district level. To create awareness, facilitate evidence-based discussions, and mobilize action for nutrition at the district level, POSHAN, created District Nutrition Profiles (DNP). These short profiles present a snapshot on the state of nutrition and its multiple determinants in selected districts, identify areas for action, and identify key data gaps and challenges. They were conceptualized to enable local leaders and civil society to understand what it takes to effectively tackle undernutrition in their communities. The available data on the nutritional status of children in India is often only available at the national and state levels with very little data at the district level, so this series is one step toward bridging this knowledge gap. To date, POSHAN has developed 46 DNPs for the states of Bihar, Jharkhand, Madhya Pradesh, Odisha, and Uttar Pradesh. POSHAN is now supporting its partners Vatsalya, Vikas Samvad and Public Health Resource Network (PHRN), to develop DNPs for all districts of Uttar Pradesh, Odisha and Madhya Pradesh.
  3. 3. CONCEPTUAL FRAMEWORK:  Causes of undernutrition at three levels—immediate, underlying, and basic 1 OVERVIEW OF THE DISTRICT NUTRITION PROFILES A conceptual framework developed by UNICEF in 1990 and modified by Black et al. (2008)1 , lays out the causes of nutrition at three levels—immediate, underlying, and basic. (See Graphic Below.) The profiles feature data, when available, on over 50 indicators, which are grouped according to these three levels along with state-level indicators as comparisons. The indicators include the following: „ Nutritional outcomes: percentages of children who are stunted, wasted, underweight, and anemic Optimum fetal and child nutrition and development IMMEDIATE • Breastfeeding, nutrient rich foods, and eating routine • Feeding and caregiving practices, parenting stimulation • Low burden of infectious diseases UNDERLYING • Food security: availability, economic access and use of food • Feeding and caregiving resources (maternal, household and community level) • Access to and use of health services, a safe and hygienic environment BASIC • Knowledge and evidence • Politics and governance • Leadership, capacity and financial resources • Social, economic, political, and environmental context (national and global) „ Immediate causes of undernutrition: rates for infant and young child feeding, immunization, supplementation, disease burden, and adolescent and maternal health services „ Underlying causes of undernutrition: data on women’s status; water, hygiene, and sanitation; food security; and socioeconomic conditions „ Basic causes of undernutrition: percentage of births attended by skilled health personnel The four-page profiles are drawn from various data sources including data from the Government of India Census, district-level surveys conducted by State Nutrition Missions, Hungama Survey, and the National Sample Survey.
  4. 4. 2 „ Using profiles from Kandhamal, Dumka, and Paschimi Singhbhum districts in the states of Odisha and Jharkhand, PHRN, together with Professional Assistance for Development Action (PRADAN), used the profiles in combination with a qualitative field assessment to identify critical areas for PRADAN to begin engaging in supporting actions for nutrition. The profiles are easy to read, with few technical terms and an abundance of infographics to facilitate understanding among the diverse stakeholders working in nutrition. Some of the profiles are translated into local language to enable a wide reach. The profiles are created and used at district-level nutrition- sensitization workshops. These workshops are attended by various district officials (District Panchayati Raj Officers, District Program Officers, Medical Officers etc.) and provide all participants the opportunity to understand and discuss the contents of the DNPs, as well as determine workable solutions/ action points informed by the data. For example, POSHAN and its partners have used the profiles in the following ways: „ In Uttar Pradesh, Vatsalya brought together district- level officials at a meeting convened by the District Development Officer to discuss the state of nutrition in Lucknow district based on the profile and identify areas for immediate action. „ In Odisha, PHRN convened a state-level meeting to present the first set of district profiles and launch a process for district-level meetings. „ In Madhya Pradesh, Vikas Samvad is in the process of conducting district workshops in Shivpuri, Khandwa, and Balaghat districts, and using the district profiles to discuss the state of nutrition. PAGE 1: Nutritional Outcomes 51.4 13.1 42.6 96.2 30.8 53.0 31.8 57.9 97.6 45.1 30.6 Children stunted (%)1,2,^ Children wasted (%)1,2,^ Children underweight (%)1,2,^ Children with any anemia (%)3,^^ Women with BMI<18.5 (%)2 Infants with birthweight <2500gms (%)4,# Adults who are obese in the district (%) Gaya Bihar 30.4% 0.1% 69.5% ^Children aged <5years; ^^Children aged <6years; #Infants 0-2 months old Source: Data source provided on Page 4 Gaya, Bihar DISTRICT NUTRITION PROFILE Page 1 THE STATE OF NUTRITION IN GAYA DISTRICT DEMOGRAPHIC PROFILE Total Population 4,391,418 MALE FEMALE RURALURBAN SC ST OTHERS CHANGES OVER TIME Bihar (Children aged <5 years) Gaya (Children aged < 5 years) 2002-04 (DLHS-2) 2005-06 (NFHS-3) 2002-04 (DLHS-2) 2011 (HUNGaMA) Stunting No data 53.0% No data 51.4% Wasting No data 31.8% No data 13.1% Underweight 49.9% 57.9% 57.3% 42.6% CHILDREN STUNTED1 CHILDREN WASTED1 NO DATA ON WOMEN’S NUTRITIONAL STATUS CHILDREN UNDERWEIGHT11 51.4% 13.1% 42.6% THE PREVALENCE OF UNDERWEIGHT HAS DECREASED IN THE DISTRICT BETWEEN 2002 AND 2011+ ! INSERT MAP +Indicators reported are specific to rural areas as HUNGaMA survey data is based on rural population NoData NoData NoData Data based on rural population Gaya ranks 562nd amongst 599 districts in India (District Development Index)13 51.6% 48.4% 13.2% 86.8%
  5. 5. 3 ‚ Page 2: Immediate Causes of Undernutrition Page 2 of the profiles present the status of interventions and practices that promote better nutrition (see image below). As shown on page 2 of Gaya’s profile, over a half of children are breastfed within 1 hour from birth but only 21.8 percent of 3–5 month olds are exclusively breastfed. In terms of adolescent and maternal health, levels of anemia among adolescent girls and pregnant women (98.5 percent and 97.4 percent respectively) in Gaya are alarming, and only 38.5 percent of women report having access to at least 1 ANC check-up. Just over a half of children in Gaya are fully immunized (57.7 percent). Only 29.6 percent of children under 2 reported having diarrhea 4 weeks prior to the survey but, 22.1 percent of children with diarrhea were treated with oral rehydration salts (ORS). READING A DISTRICT NUTRITION PROFILE ƒ Page 1: Nutritional Outcomes Page 1 of the profiles provides information on the demographics of and nutritional status of the district (see image at left). Using the example of Gaya’s DNP, page 1 of the profile shows that Gaya is predominantly rural, with less than a third of people belonging to scheduled castes and a majority belonging to other minority groups. Gaya ranks 562nd out of 599 districts in India, in the District Development Index (an index which averages district economic development, material wellbeing, educational development, and health indices). The DNP also shows that over half of the district’s children are stunted and over 40 percent are underweight. The DNP compares each district to its respective state. In Gaya’s case, roughly the same percent of children under 5 are stunted in Gaya and Bihar, but Gaya has significantly less wasting (13.1 percent) than Bihar (31.8 percent). The profile also shows that anemia rates for children under 6 in Gaya and in Bihar are also very high, reaching over 95 percent in both areas. The DNP shows changes in nutrition over time. One promising evolution has been that the prevalence of underweight in Gaya decreased by 14.7 percent between 2002 and 2011. PAGE 2: Immediate Causes of Undernutrition 60.0 39.5 21.8 37.9 55.2 57.7 48.3 29.6 22.1 35.5 57.0 67.7 43.5 42.4 42.8 65.9 51.8 31.1 32.5 39.1 Early initiation of breastfeeding (%) Exclusive breastfeeding (0-2 months old) (%) Exclusive breastfeeding (3- 5 months old) (%) Children (6-8 months) who received any solid/semi solid food in the last 24 hours (%) Children (9-11 months old) who achieve minimum diet diversity (%) Full immunization coverage (%)^ Children who got vitamin A supplementation (%)^^ Children who suffered from diarrhoea in previous 4 weeks (%)^ Children with diarrhoea who were treated with ORS (%)^ Children who suffered from ARI in the previous 4 weeks (%)^ DISEASE BURDEN4^ Page 2 Child undernutrition is caused by inadequacies in food, health and care for infants and young children, especially in the first two years of life (immediate causes). Inadequate food, health and care arise from food insecurity, unsanitary living conditions, low status of women, and poor health care (underlying causes). These are, in turn, caused by social inequity, economic challenges, poor political will and leadership to address these causes (basic causes). Interventions to address undernutrition must address these multiple causes of undernutrition and do so in an equitable manner. IMMEDIATE CAUSES OF UNDERNUTRITION IMMEDIATE CAUSES Breastfeeding, nutrient rich foods, and eating routine Feeding and caregiving practices, parenting stimulation Low burden of infectious diseases Optimum fetal and child nutrition and development WHAT FACTORS CAUSE UNDERNUTRITION?6 UNDERLYING CAUSES Food security: availability, economic access and use of food Feeding and caregiving resources (maternal, household and community level) Access to and use of health services, a safe and hygienic environment BASIC CAUSES Knowledge and evidence Politics and governance Leadership, capacity and financial resources Social, economic, political, and environmental context (national and global) The most crucial period for child nutrition is from pre-pregnancy to the second year of life2 HOW CAN NUTRITION IMPROVE? ADOLESCENT & MATERNAL HEALTH3,5 INFANT AND YOUNG CHILD FEEDING4 0 10 20 30 40 50 60 70 80 90 100 Age of child (in months) Percentageofchildstunting(%) Window of opportunity Too late IMMUNIZATION & SUPPLEMENTATION4,5 ^Children aged 12-23 months; ^^Children aged 12-35 months; # Girls aged 10-19 years; Source: Data source provided on Page 4 38.5 97.4 98.5 59.1 97.1 99.2 Women with access to any antenatal care (at least 1 visit) (%) Any anemia among pregnant women (%) Any anemia among adolescent girls (%)# Gaya Bihar • Poor state of infant and young child feeding: low rates of diet diversity amongst infants • Low rates of immunization and vitamin A supplementation, which needs urgent attention • Alarming levels of anaemia among pregnant women and adolescent girls Areas for action: Data challenges: • Out-dated data; poor availability of data on key immediate determinants of under nutrition from national surveys • Where data are available, indicator definitions are non-standardized and often differ from World Health Organisation recommendations
  6. 6. 4 Page 3: Underlying and Basic Causes of Undernutrition „ Page 3 of the profiles present the status of women, water and sanitation, food security, and socioeconomic conditions, which are strongly linked to nutrition (see image at right). In the case of Gaya, early marriage of girls is highly prevalent, with over half of girls married by the age of 18. In the area of water and sanitation, only 20.8 percent of households in Gaya have access to improved sanitation facilities, which may be the primary cause of high rates of open defecation (74.8 percent). Alarmingly, only less than half of households report washing their hands with soap before consuming a meal, although a majority of households have access to improved drinking water sources (87.9 percent). In terms of food security, more than half of households in Gaya spend half of their income on food. Out of total food expenditure, 39 percent is spent on cereals. Socioeconomic conditions in Gaya are poor, with 24.6 percent of households living below the poverty line, only 16.3 percent of households having access to electricity, and less than half of the households (42.5 percent) living in a permanent house. Additionally, over half of the adults in Gaya are illiterate, and only less than a half of households avail of bank services. PAGE 3: Underlaying and Basic Causes of Undernutrition 51.1 87.9 20.8 74.8 42.745.9 7.8 9.2 93.3 19.5 75.8 73.3 57.2 Girls married when <18years old (%) Ever married women/mothers who completed primary school (%) Women who completed middle school (%) Women's ownership of land (%) Women's ownership of livestock (%) Access to improved drinking water sources (%) Access to improved sanitation facilities (%) Open defecation (%) Child stool disposal in a sanitary manner (%) Households who washed hands with soap before a meal (%)^ 52.8 39.0 53.3 24.6 51.1 42.5 16.3 49.4 34.8 53.2 34.1 50.9 48.1 16.4 Household share of expenditure on food (%) Household share of food expenditure on cereals (%) Households in the district involved in agriculture (%) Below Poverty Line households (%) Households ownership of agricultural land (%) Households living in a permanent house (%) Access to electricity (%) Gaya Bihar SOCIO ECONOMIC CONDITIONS7,9 Page 3 UNDERLYING CAUSES OF UNDERNUTRITION BASIC CAUSES OF UNDERNUTRITION • Per capita gross district domestic product of Gaya ranked 13th amongst 38 district of Bihar in 2011-1214. • Bihar’s per capita income ranks last amongst 32 major States/UTs in India in 2011-1215. NoData NoData NoData NoData NoData NoData NoData WOMEN’S STATUS5 WATER, SANITATION AND HYGIENE2,4,7 FOOD SECURITY8 ^Household with a child aged 6-8 months; Source: Data source provided on Page 4 52.3 25.8 100.0 25.6 81.4 38.4 47.450.4 31.7 91.7 32.7 91.7 57.2 44.4 Adult literacy rate (%)12 Births attended by skilled health personnel (%)5 Household has access to Anganwadi Worker (%)5 Household has access to a Sub Health Centre (%)5 Household has access to Primary/Middle School (%)5 Households who demanded and received work through NREGA (%)11 Households availing Bank services (%)7 Gaya Bihar Areas for immediate action: • Very high rates of open defecation; critical need to increase awareness about washing hands with soap and ensuring access to using improved sanitation facilities • Early marriage of girls less than 18 years is highly prevalent; early marriage is related to poor health and nutrition outcomes for mothers and babies • Food insecurity, especially diet quality, is a challenge that can holdback improvements in nutrition • Very few households live in a permanent house and have access to electricity Data challenges: • Difficult to compare indicators of water, sanitation and hygiene over time as census data do not provide data on child stool disposal or on hand washing • Access to skilled health personnel and Sub-Health Centres is very limited • Action needs to be taken to improve adult literacy which is low • No data available on indicators of governance and political will to address nutrition
  7. 7. 5  Page 4: Evaluation of Health and Nutrition Schemes The last section of the profile will differ among states. In some cases it will be a space for participants in nutri- tion-sensitization workshops to note action points to improve nutrition in their communities, while in others it will present a set of indicators on the performance of health and nutrition schemes in the state and district, from state-level surveys. In Gaya’s case, it is the latter (see image above). Less than half of the eligible households in Gaya, with children 0–2 months old, receive any take home ration (31.4 percent), and financial assistance for delivery and child care (23 percent). On a positive note, a majority of households (62.6 percent) report having institutional deliveries and 85 percent of households with a 12–23 month old child are equipped with an immunization/MCP card. PAGE 4: Evaluation of Health and Nutrition Schemes Data sources 1. Author’s estimates based on HUNGaMA: Fighting Hunger & Malnutrition: the HUNGaMA Survey Report. 2011. Naandi Foundation. 2. Author’s estimates based on National Family Health Survey (NFHS-3), 2005-06, India. Mumbai: International Institute for Population Studies. 3. Author’s estimates based on District Level Household Survey on Reproductive and Child Health (DLHS-2), 2002-04, India. International Institute for Population Studies. (IIPS). 2006. District Level Household Survey on Reproductive and Child Health (DLHS-2), 2002-04, India: Nutritional Status of Children and Prevalence of Anemia among Children, Adolescent Girls and Pregnant Women. Mumbai: IIPS. March 18, 2015, www.rchiips.org/pdf/rch2/National_Nutrition_Report_RCH-II.pdf 4. Concurrent Household Health and Nutrition Survey (Round-6), Concurrent Monitoring and Learning Unit, CARE India – Bihar 5. International Institute for Population Studies (IIPS). 2010. District Level Household Survey and Facility Survey (DLHS-3), 2007-08, India, Uttar Pradesh. Mumbai: IIPS. Accessed March 18, 2015, http://www.rchiips.org/pdf/rch3/report/bh.pdf 6. Robert E Black, Cesar G Victora, Susan P Walker, Zulfiqar A Bhutta, Parul Christian, Mercedes de Onis, Majid Ezzati, Sally Grantham-McGregor, Joanne Katz, Reynaldo Martorell, Ricardo Uauy, and the Maternal and Child Nutrition Study Group. 2013. “Maternal and Child Undernutrition and Overweight in Low-Income and Middle- Income Countries”. The Lancet 382 (9890), 427-451. 7. Census of India. 2011. Houselisting and Housing Census Data. Accessed March 18, 2015, www.censusindia.gov.in/2011census/hlo/HLO_Tables.html 8. Author’s estimates based on Household Consumption Expenditure, National Sample Survey Office (NSSO) 68th Round, 2011-12. Ministry of Statistics and Program Implementation. Government of India. 9. Planning Commission. 2013. Press note on poverty estimates, 2011-12. Government of India. Accessed March 18, 2015. http://planningcommission.nic.in/news/pre_pov2307.pdf 10. Finance Department, Government of Bihar. Economic Survey Report 2011-12: Gross District Domestic Product at Constant Prices (2005-06). Accessed March 18, 2015, http://finance.bih.nic.in/Documents/Reports/Economic-Survey-2012-EN.pdf 11. Author’s estimates based on Employment and Unemployment, National Sample Survey Office (NSSO) 68th Round, 2011-12. Ministry of Statistics and Program Implementation. Government of India. 12. Census of India. 2011. Primary Census Abstract. Accessed June 6, 2015, www.censusindia.gov.in/pca/default.aspx 13. Us-India Policy Institute. 2015. District Development and Diversity Index. Accessed July 2, 2015, http://www.usindiapolicy.org/updates/general-news/225-district- development-and-diversity-index-report 14. Government of Bihar. 2015. Economic Survey 2014-15. Accessed July 2,2015, http://finance.bih.nic.in/Documents/Reports/Economic-Survey-2015-EN.pdf 15. Government of India. 2014. State-wise Per Capita Income and Gross Domestic Product at current prices. Accessed July 2, 2015, http://pib.nic.in/archieve/others/2014/aug/d2014070801.pdf This District Nutrition Profile was developed by Srabashi Ray for POSHAN. This version, dated 20-07- 2015 is a draft intended for use in a district-level workshop in Gaya, and will be revised following workshop discussions EVALUATION OF HEALTH AND NUTRITION SCHEMES FLW visits4 ^Infants aged 0-2 months; ^^2 recommended visits; *3 recommended visits; Source: Data source provided on Page 4 Last Trimester^^ Within 1 week of delivery* Within 24 hours of delivery*No Visit Less than recommended Equal to recommended More than recommended No Visit Less than recommended Equal to recommended More than recommended Bihar 58.9% 5.8% 10.1% 25.3% 67.3% 21.3% 4.8% 6.6% 27.4% Gaya 58.2% 7.1% 7.9% 26.7% 60.4% 27.9% 4.5% 7.3% 33.6% 62.6 85.0 31.4 23.0 71.8 83.2 42.0 26.4 Institutional deliveries (%)^ Households (with a 12- 23 month old child) with an immunization/MCP card (%) Households that receive any take home ration (%)^ Any financial assistance to households for delivery and childcare (%)^ Gaya Bihar Source:SavetheChildren/India/2009 Areas for immediate action: • Less than half of the eligible household receive any take home ration • A majority of households with a pregnant woman/new-born child were not visited by any FLW • Only a few households receive financial assistance for delivery and child care Data challenges: • Lack of data on assessing the implementation of government schemes Frequency of frontline worker (FLW) visits to house- holds with a pregnant woman/new born child however, is poor. In Gaya, 58.2 percent of women are not visited by FLWs in the last trimester. Even fewer women are visited within 1 week of delivery, with only 27.9 percent receiving at least three recommended visits. Alarmingly, only 33.6 percent of women are visited 24 hours prior to delivery. LESSONS AND CHALLENGES IN PREPARING THE DISTRICT NUTRITION PROFILE The lack of recent and reliable district-level data on nutrition is the biggest challenge in preparing these profiles. None of the profiles has all the data on nutrition, and often, the data that does exist is outdated. In the case of Gaya, data on recommended
  8. 8. 6 CONCLUSION POSHAN is excited to be supporting such a diverse set of knowledge mobilization partners in convening nutrition conversations using the District Nutrition Profiles. These profiles are a foundation for transforming the nutrition situation in any district. The challenge for all districts will be to collect timely and relevant data on nutrition-related indicators through surveys. To make this happen, strong governance and leadership is required. The absence of data, highlighted in the profiles can be used to initiate policy dialogue and engagement among policymakers at the district, state, and national levels to take action. IYCF practices, women’s status, low birth weight infants, adult obesity, and governance and political will to address undernutrition, is all currently unavailable. For the data that is available, indicator definitions are not standardized, varying across surveys and reports, and often differ from the World Health Organization’s recommendations. This makes it challenging to make comparisons over time. „ Sampling differences: Some of the data sources provided only rural data and used smaller samples. This made it difficult to compare indicators from these data sources with data available from national level surveys. „ Data skills: Some data, e.g., on food security and diet diversity, require the use of unit-level data from large, complex data sources such as National Sample Survey Organization (NSSO) data. Others are less challenging e.g., water-sanitation indicators and access to services, which can be almost directly obtained from the census reports.
  9. 9. 7 ANNEX 1: INDICATOR DEFINITION AND SOURCES Choice of Indicators District Nutrition Profiles feature a set of indicators on the state of nutrition and its multiple determinants in India based on diverse sources of data. A conceptual framework developed by UNICEF in 1990 and modified by Black et al. (2008) lays out the causes of nutrition at three levels—immediate, underlying, and basic. The profiles feature district-level indicators that are grouped by these three levels and an associated state-level indicator as a comparison as well as overall indicators for district demographics and nutrition status. POSHAN is regularly tracking data sources as they are released and updating the profiles accordingly. These are all featured at: http://poshan.ifpri.info/district-nutrition-profiles/. PLEASE NOTE: Indicator definitions and sources will vary among states. The following indicators and sources are specific to Bihar. District Profile Indicators DEMOGRAPHICS Indicator Indicator Definition Unit State Source District Source Additional Information Total Population Number of individuals living in the district Persons Government of India 2011 Government of India 2011 Census 2011 URL: http://www. censusindia.gov. in/2011census/ population_ enumeration.html Population Enumeration Data (Final Population) >> Primary Census Abstract Data (Final Population)>> Primary Census Abstract Data Tables (India & States/UTs - District Level) (Excel Format) Male Population Numerator: number of males living in the district Denominator: total population Persons Female Population Numerator: number of females living in the district Denominator: total population Persons Urban Population Numerator: number of individuals living in urban areas Denominator: total population Persons Rural Population Numerator: number of individuals living in rural areas Denominator: total population Persons Scheduled Caste Population Numerator: number of individuals belonging to a scheduled caste living in the district Denominator: total population Percentage Scheduled Tribe Population Numerator: number of individuals belonging to a scheduled tribe living in the district Denominator: total population Percentage Other Population Numerator: number of individuals belonging to a other backward classes or general (non-disadvantaged castes) living in the district Denominator: total population Percentage
  10. 10. 8 NUTRITION STATUS Indicator Indicator Definition Unit State Source District Source Additional Information Children stunted Numerator: number of children aged 0–5 years who are stunted Denominator: all children aged 0–5 years Stunting: height-for-age less than –2 standard deviations of the WHO Child Growth Standards2 median Percentage National Family Health Survey 3 (NFHS3) 2005–06 HUNGaMA 20113 /NO DATA CURRENTLY AVAILABLE Author’s estimates from NFHS3 and HUNGaMA 2011 datasets NO DATA CURRENTLY AVAILABLE at the district level for non-HUNGaMA districs Children wasted Numerator: number of children aged 0–5 years who are wasted Denominator: all children aged 0–5 years Wasting: weight-for-height less than –2 standard deviations of the WHO Child Growth Standards median Percentage NFHS3 2005–06 HUNGaMA 2011/NO DATA CURRENTLY AVAILABLE Author’s estimates from NFHS3 and HUNGaMA 2011 datasets NO DATA CURRENTLY AVAILABLE at the district level for non-HUNGaMA districs Children underweight Numerator: number of children aged 0–5 years who are underweight Denominator: all children aged 0–5 years who are underweight Underweight: weight-for-age less than –2 standard deviations of the WHO Child Growth Standards median Percentage NFHS3 2005–06 HUNGaMA 2011/District Level Household Survey 2 (DLHS2) 2002–04 Author’s estimates from NFHS3 and HUNGaMA 2011 datasets For non-HUNGaMA districts, author estimate from DLHS2 dataset Children with any anemia Numerator: number of children aged 0–71 months (of mothers aged 15–44 years) classified as having iron-deficiency anemia Denominator: all children aged 0–71 months (of mothers aged 15–44 years) Anemia: Hemoglobin (Hb) <12 g/dL (mild/ moderate/severe) Percentage District Level Household Survey 2 (DLHS2) 2002–04 DLHS2 2002–04 Url: http://www.rchiips.org/ pdf/rch2/National_Nutrition_ Report_RCH-II.pdf APPENDIX A ‘District-wise Indicators of Nutritional Status, Anaemia among Children: Mild+ Moderate+ Severe’ Women underweight Numerator: number of women aged 15–49 years with body mass index (BMI) <18.5 Denominator: all women aged 15–49 years BMI: mass (kilograms)/ height2 (meters) Percentage NFHS3 2005–06 State Report NO DATA CURRENTLY AVAILABLE URL: http://www.rchiips.org/ nfhs/NFHS-3%20Data/Bihar_ report.pdf TABLE 56 NUTRITIONAL STATUS OF ADULTS Under column ‘total thin’ Children with low birth weight Numerator: number of children aged 0–2 months with birth weight of less than 2500 grams Denominator: all children aged 0–2 months Percentage Concurrent Household Health and Nutrition Survey, 6th Round (CHHNS6) 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Obesity among adults Prevalence of obesity among adults (Body Mass Index ≥ 30) Percentage NO DATA CURRENTLY AVAILABLE NO DATA CURRENTLY AVAILABLE NOT APPLICABLE
  11. 11. 9 IMMEDIATE CAUSES Indicator Indicator Definition Unit State Source District Source Additional Information Early initiation of breastfeeding Numerator: number of children aged 0–2 months who were breastfed within 1 hour of birth Denominator: all children aged 0–2 months Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Exclusive breastfeeding (0–2 months) Numerator: number of children aged 0–2 months who were exclusively breastfed for in the last 24 hours Denominator: all children aged 0–2 months Note: Based on mother’s report for their youngest child Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Exclusive breastfeeding (3–5 months) Numerator: number of children aged 3–5 months who were exclusively breastfed for in the last 24 hours Denominator: all children aged 3–5 months Note: Based on mother’s report for their youngest child Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Children aged 6–8 months who received any solid/semi solid food in the last 24 hours Numerator: number of children aged 6–8 months who received any solid, semi-solid, or soft foods in the last 24 hours Denominator: all children aged 6–8 months Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Children aged 9–11 months who achieve minimum diet diversity Numerator: number of children aged 9–11 months whose diet included foods from at least four or more food groups Denominator: all children aged 9–11 months Note: Food groups include grains; roots and tubers; legumes and nuts; dairy products (milk, yogurt, cheese); flesh foods (meat, fish, poultry and liver/organ meats); eggs; vitamin-A rich fruits and vegetables; other fruits and vegetables Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Full immunization coverage Numerator: number of children aged 12–23 months who received Bacille Calmette- Guerin (BCG), three injections of diphtheria, pertussis and tetanus (DPT), three doses of Polio (excluding Polio 0) and measles immunizations Denominator: all children aged 12–23 months Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset
  12. 12. 10 IMMEDIATE CAUSES continued Indicator Indicator Definition Unit State Source District Source Additional Information Children aged 12–35 months who received vitamin A Numerator: number of children (of mothers aged 15–49 years) aged 12–35 months who received at least one dose of vitamin A Denominator: all children (of mothers aged 15–49 months) aged 12–35 months Percentage District Level Household Survey 3 (DLHS3) 2007–08 State Report DLHS3 2007–08 State Report DLHS-3 State Report TABLE 5.7 CHILDHOOD VACCINATION BY DISTRICTS Under column ‘Percentage received at least one dose of vitamin A’ Acute diarrhea in children Numerator: number of children aged 12–23 months who suffered from diarrhea 4 weeks prior to the survey Denominator: all children aged 12–23 months Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Children with diarrhea treated with ORS Numerator: number of children aged 12–23 months who suffered from diarrhea and were given ORS Denominator: all children aged 12–23 months Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Children who suffered from ARI Numerator: number of children aged 12–23 months who suffered from Acute Respiratory Infections (ARI) 4 weeks prior to the survey years aware of danger signs of pneumonia Denominator: all children aged 12–23 months Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Women with access to any antenatal care (at least 1 visit) Numerator: number of women aged 15–49 years who received any antenatal care (ANC) during pregnancy Denominator: all women aged 15–49 years Note: Based on women who had their last live/still birth since 01-01-2004 Percentage DLHS3 2007–08 State Report DLHS3 2007–08 State Report DLHS-3 State Report TABLE 4.2 ANTENATAL CARE BY DISTRICT Under column ‘Any ANC’ Any anemia among pregnant women Numerator: number of pregnant women aged 15–44 years classified as having iron- deficiency anemia Denominator: all pregnant women aged 15–44 years Iron-deficiency anemia: Hb <12 g/dL (mild/ moderate/severe) Percentage DLHS2 2002–04 DLHS2 2002–04 Url: http://www.rchiips. org/pdf/rch2/National_ Nutrition_Report_RCH-II.pdf APPENDIX A ‘District-wise Indicators of Nutritional Status, Anaemia among Pregnant Women: Mild+ Moderate+ Severe’ Any anemia among adolescent girls Numerator: number of adolescent girls aged 10–19 years classified as having iron- deficiency anemia Denominator: all adolescent girls aged 10–19 years Iron-deficiency anemia: Hb <12 g/dL (mild/ moderate/severe anemia) Percentage DLHS2 2002–04 DLHS2 2002–04 Url: http://www.rchiips. org/pdf/rch2/National_ Nutrition_Report_RCH-II.pdf APPENDIX A ‘District-wise Indicators of Nutritional Status, Anaemia among Adolescent Girls: Mild+ Moderate+ Severe’
  13. 13. 11 UNDERLYING CAUSES Indicator Indicator Definition Unit State Source District Source Additional Information Women’s status Girls married when <18years old Numerator: number of women aged 15–18 years who were married below legally prescribed minimum age Denominator: all women aged 15–18 years Legally prescribed minimum age: 18 years Percentage DLHS3 2007–08 State Report DLHS-3 2007–08 State Report DLHS-3 State Report TABLE 2.3 AGE AT MARRIAGE Under column ‘Percentage of marriages below legal age at marriage- Girls (<18 years)’ Women who completed primary school Numerator: number of ever-married women aged 15–49 years who have completed primary school education Denominator: all ever-married women aged 15–49 years Primary school: 0–5 years of schooling Percentage DLHS3 2007–08 State Report NO DATA CURRENTLY AVAILABLE DLHS-3 State Report TABLE 3.2 LEVEL OF EDUCATION OF EVER-MARRIED WOMEN Under column ‘Years of schooling 0–5 years’ Women who completed secondary school Numerator: ever-married women aged 15–49 years who have completed secondary school education Denominator: all ever-married women aged 15–49 years Secondary school: 6–8 years of schooling Percentage DLHS3 2007–08 State Report NO DATA CURRENTLY AVAILABLE DLHS-3 State Report TABLE 3.2 LEVEL OF EDUCATION OF EVER-MARRIED WOMEN Under column ‘Years of schooling 6–8 years’ Women's ownership of land Numerator: number of women that own any land Denominator: all women Percentage NO DATA CURRENTLY AVAILABLE NO DATA CURRENTLY AVAILABLE NOT APPLICABLE Women's ownership of livestock Numerator: number of women who own livestock Denominator: all women Percentage NO DATA CURRENTLY AVAILABLE NO DATA CURRENTLY AVAILABLE NOT APPLICABLE WASH (Water, Sanitation, and Hygiene) Access to improved drinking-water sources Numerator: number of households using improved drinking water source Denominator: total number of households in the area Improved drinking water sources: Piped water into dwelling, plot or yard, public tap/stand pipe, tube well/borehole, protected dug well, protected spring and rainwater collection Percentage Government of India 2011 Government of India 2011 Census 2011 HH-6: HOUSEHOLDS BY MAIN SOURCE OF DRINKING WATER AND LOCATION URL: http://www.censusindia. gov.in/2011census/hlo/District_ Tables/Distt_table/10/HH2206- 1000CRCD.pdf Access to improved sanitation facilities Numerator: number of households in the district using improved sanitation facilities Denominator: total number of households in the area Improved sanitation facilities: Piped sewer system, septic tank, pit latrine with slab Percentage Government of India 2011 Government of India 2011 Census 2011 HH-8: HOUSEHOLDS BY AVAILABILITY OF TYPE OF LATRINE FACILITY URL: http://www.censusindia. gov.in/2011census/hlo/District_ Tables/Distt_table/10/HH2808- 1000DCRC.pdf
  14. 14. 12 UNDERLYING CAUSES continued Indicator Indicator Definition Unit State Source District Source Additional Information WASH (Water Sanitation Hygiene) continued Open defecation Numerator: number of households that defecate in the open Denominator: total number of households in the area Percentage Government of India 2011 Government of India 2011 Census 2011 HH-8: HOUSEHOLDS BY AVAILABILITY OF TYPE OF LATRINE FACILITY URL: http://www.censusindia. gov.in/2011census/hlo/ District_Tables/Distt_table/10/ HH2808-1000DCRC.pdf Child stool disposal in a sanitary manner Numerator: mothers who have a child aged 0–5 years whose stools are disposed safely Denominator: all mothers in the sample Percentage NFHS3 2005–06 NO DATA CURRENTLY AVAILABLE Author’s estimate from NFHS-3 dataset Hand washing with soap before meals Numerator: number of households that reported washing their hands with soap before a meal Denominator: total number of households in the area Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Socio Economic Conditions Population living below the poverty line in the district Numerator: number of persons who live below the state and sector specific poverty line Denominator: total population of the area Note: The poverty lines are taken from the Tendulkar estimates of the planning commission4 . Sector implies rural or urban areas. Percentage National Sample Survey, 68th Round (NSS68) 2011-12 consumption expenditure NSS68 2011-12 consumption expenditure Author’s estimate from NSSO data State / District probability weighted mean (not representative at district level) Households who own agricultural land Numerator: number of households that own and cultivate land in rural areas Denominator: total number of households in the area Percentage NSS68 2011-12 employment and unemployment NSS68 2011-12 employment and unemployment Author’s estimate from NSSO data State / District probability weighted mean (not representative at district level) Households living in a ‘pucca’ house Numerator: number of households that have a ‘pucca’ house Denominator: total number of households in the area pucca= permanent Percentage Government of India 2011 Government of India 2011 Census 2011- HH-13 : HOUSEHOLDS BY TYPE OF STRUCTURE OF THE CENSUS HOUSES OCCUPIED URL: http://www.censusindia. gov.in/2011census/hlo/ District_Tables/Distt_table/10/ DDW-HH4313-1000.pdf Household access to electricity Numerator: number of households that have access to and use electricity as their main source of lighting Denominator: total number of households in the area Percentage Government of India 2011 Government of India 2011 Census 2011- HH-7: HOUSEHOLDS BY MAIN SOURCE OF LIGHTING URL: http://www.censusindia. gov.in/2011census/hlo/ District_Tables/Distt_table/10/ HH2507-1000CRCD.pdf
  15. 15. 13 UNDERLYING CAUSES continued Indicator Indicator Definition Unit State Source District Source Additional Information Food Security Household share of expenditure on food Numerator: food expenditure per-capita Denominator: total consumption expenditure per-capita Percentage NSS68 2011-12 consumption expenditure NSS68 2011-12 consumption expenditure Author’s estimate from NSSO data State / District probability weighted mean (not representative at district level) Household share of food expenditure on cereals Numerator: cereal expenditure per-capita Denominator: total food expenditure per-capita Percentage NSS68 2011-12 consumption expenditure NSS68 2011-12 consumption expenditure Author’s estimate from NSSO data State / District probability weighted mean (not representative at district level) Households involved in agriculture Numerator: number of households who are either self-employed or casual laborers in agriculture Denominator: total number of households in the area Percentage NSS68 2011-12 consumption expenditure NSS68 2011-12 consumption expenditure Author’s estimate from NSSO data State / District probability weighted mean (not representative at district level) Other Indicators Adult literacy rate Numerator: number of persons aged 7 years and above who can both read and write in any language Denominator: total number of persons aged 7 years and above Percentage Government of India 2011 Government of India 2011 URL: http://www.censusindia. gov.in/2011census/ population_enumeration.html Population Enumeration Data (Final Population) >> Primary Census Abstract Data (Final Population)>> Primary Census Abstract Data Tables (India & States/UTs - District Level) (Excel Format) [Total literates/Total Population]*100 District rank of Per Capita Gross District Domestic Product (GDDP) Gross District Domestic Product (GDDP) 2011–12 Note: Deflated to 2004–2005 prices Rank Directorate of Economic and Statistics, State Government Directorate of Economic and Statistics, State Government Table A 1.7 URL: http://finance.bih.nic. in/Documents/Reports/ Economic-Survey-2015-EN.pdf District Development Index (DDI) rank Rank based on overall index of all socio- religious communities (SRCs). The overall index is calculated by taking the average of a district’s Economic Development Index, Material Wellbeing Index, Educational Development Index, and Health Index Note: From well-performing districts to poor-performing districts Rank (1–599) NOT APPLICABLE District Development and Diversity Index, Report for India and Major States, US-India Policy Institute and CRDDP URL: http://www. usindiapolicy.org/updates/ general-news/225-district- development-and-diversity- index-report
  16. 16. 14 BASIC CAUSES Indicator Indicator Definition Unit State Source District Source Additional Information Access to Services Births attended by skilled health personnel Numerator: number of women aged 15–49 years who had a safe delivery Denominator: all women aged 15–49 years Safe delivery: institutional or home delivery assisted by skilled personnel Percentage DLHS3 2007–08 State Report DLHS3 2007–08 State Report DLHS-3 State Report TABLE 4.9 PLACE OF DELIVERY AND ASSISTANCE CHARACTERISTICS BY DISTRICT Under column: ‘Percentage of safe delivery’ Household has access to Anganwadi Worker Numerator: number of households that have access to an Anganwadi worker Denominator: total number of households Percentage DLHS3 2007–08 State Report DLHS3 2007–08 State Report DLHS-3 State Report TABLE 2.12 AVAILABILITY OF FACILITY AND HEALTH PERSONNEL BY DISTRICT Household has access to a sub health center Numerator: number of households that have access to a health center Denominator: total number of households Percentage DLHS3 2007–08 State Report DLHS3 2007–08 State Report DLHS-3 State Report TABLE 2.12 AVAILABILITY OF FACILITY AND HEALTH PERSONNEL BY DISTRICT Household has access to primary/middle school Numerator: number of households that have access to a primary/ middle school Denominator: total number of households Percentage DLHS3 2007–08 State Report DLHS3 2007–08 State Report DLHS-3 State Report TABLE 2.12 AVAILABILITY OF FACILITY AND HEALTH PERSONNEL BY DISTRICT Households who demanded and received work through NREGA Numerator: number of households that received an NREGA job Denominator: total number of households that demanded an NREGA job Note: NREGA= National Rural Employment Guarantee Act Percentage NSS68 2011-12 employment and unemployment NSS68 2011-12 employment and unemployment Author’s estimates from NSSO data State / District probability weighted mean (not representative at district level) Households availing bank services Numerator: number of households availing bank services Denominator: total number of households Percentage Government of India 2011 Government of India 2011 Census 2011 HH-12: NUMBER OF HOUSEHOLDS AVAILING BANKING SERVICES AND NUMBER OF HOUSEHOLDS HAVING EACH OF THE SPECIFIED ASSETS URL: http://www.censusindia.gov. in/2011census/hlo/District_Tables/ Distt_table/10/HH4012-1000DCRC. pdf
  17. 17. 15 EVALUATION OF HEALTH AND NUTRITION SCHEMES Indicator Indicator Definition Unit State Source District Source Additional Information Policy Institutional delivery Numerator: number of children aged 0–2 months who were delivered in a medical institution Denominator: all children aged 0–2 months Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Households with an MCP card Numerator: number of households with a 12–23 months old child who has a MCP card Denominator: all households with a 12–23 months old child Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Households receiving take home ration Numerator: number of households with a 0–2 month child who receives any take home ration Denominator: all households with a 0–2 months old child Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset Households receiving any financial assistance Numerator: number of households with a 0–2 months old child who received any financial assistance for child delivery and care Denominator: all households with a 0–2 months old child Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset FLW visits Frequency of FLW visits compared with the recommended number of visits during a. Last trimester b. First week of delivery Numerator: number of household with a 0–2 months old baby where no visits were conducted/less than recommended/ recommended/more than recommended in the last trimester/first week of birth Denominator: all households with a 0–2 months old baby Note: The calculations were done separately for two periods – last trimester; one week after delivery (home visits)/one week of the mother’s return home (institutional delivery) Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset; Recommended number of visits in the last trimester = 2 Recommended number of visits in the first week of delivery (home delivery)/mother’s return (institutional delivery) = 3 Any FLW visit within 24 hours of delivery in case of home delivery Numerator: Number of households with a 0–2 months old baby where a home visit was conducted on the day of the delivery in case of a home delivery Denominator: all households with a 0–2 months old baby who was delivered at home Percentage CHHNS6 2014 CHHNS6 2014 Author’s estimates from CHHNS6 2014 dataset
  18. 18. 16 NOTES 1. Robert E. Black, Cesar G. Victora, Susan P. Walker, Zulfiqar A. Bhutta, Parul Christian, Mercedes de Onis, Majid Ezzati, Sally Grantham-McGregor, Joanne Katz, Reynaldo Martorell, Ricardo Uauy, and the Maternal and Child Nutrition Study Group. 2013. “Maternal and Child Undernutrition and Overweight in Low-Income and Middle- Income Countries”. The Lancet 382 (9890), 427-451. 2. WHO (World Health Organization). 2006. WHO Child Growth Standards. Geneva. Available at http://www.who.int/childgrowth/standards/Technical_report.pdf 3. For districts with HUNGaMA data, only rural comparisons are made. Only the rural averages are reported from the NFHS-3 at the state level (because HUNGaMA data was based on rural regions only). For Non-HUNGaMA districts there is no data currently available at the district level for stunting and wasting. There is however data for underweight at the district level. For such districts date is reported for both rural and urban regions. Please note that the DLHS-2 figures for child underweight are computed and sourced from the report because by definition it pertains to children who are 0–5 years. 4. Planning Commission. 2013. Press note on poverty estimates, 2011-12. Government of India. Accessed March 18, 2015. http://planningcommission.nic.in/news/pre_pov2307.pdf
  19. 19. 17 REFERENCES Author’s estimates based on HUNGaMA: Fighting Hunger & Malnutrition : the HUNGaMA Survey Report. 2011. Naandi Foundation. Author’s estimates based on National Family Health Survey (NFHS-3), 2005-06, India. Mumbai: International Institute for Population Studies. Author’s estimates based on District Level Household Survey on Reproductive and Child Health (DLHS-2), 2002-04, India. International Institute for Population Studies. (IIPS). 2006. District Level Household Survey on Reproductive and Child Health (DLHS-2), 2002-04, India: Nutritional Status of Children and Prevalence of Anemia among Children, Adolescent Girls and Pregnant Women. Mumbai: IIPS. March 18, 2015, www.rchiips.org/pdf/rch2/ National_Nutrition_Report_RCH-II.pdf Concurrent Monitoring and Learning Unit, CARE. 2014. Concurrent Household Health and Nutrition Survey, 6th Round. Bihar, India. International Institute for Population Studies (IIPS). 2010. District Level Household Survey and Facility Survey (DLHS-3), 2007-08, India, Uttar Pradesh. Mumbai: IIPS. Accessed March 18, 2015, http://www.rchiips.org/pdf/ rch3/report/bh.pdf Robert E Black, Cesar G Victora, Susan P Walker, Zulfiqar A Bhutta, Parul Christian, Mercedes de Onis, Majid Ezzati, Sally Grantham-McGregor, Joanne Katz, Reynaldo Martorell, Ricardo Uauy, and the Maternal and Child Nutrition Study Group. 2013. “Maternal and Child Undernutrition and Overweight in Low-Income and Middle-Income Countries”. The Lancet 382 (9890), 427-451. Census of India. 2011. Houselisting and Housing Census Data. Accessed March 18, 2015, www.censusindia.gov. in/2011census/hlo/HLO_Tables.html Author’s estimates based on Household Consumption Expenditure, National Sample Survey Office (NSSO) 68th Round, 2011-12. Ministry of Statistics and Program Implementation. Government of India. Planning Commission. 2013. Press note on poverty estimates, 2011-12. Government of India. Accessed March 18, 2015. http://planningcommission.nic.in/news/pre_pov2307.pdf Author’s estimates based on Employment and Unemployment, National Sample Survey Office (NSSO) 68th Round, 2011-12. Ministry of Statistics and Program Implementation. Government of India. Census of India. 2011. Primary Census Abstract. Accessed June 6, 2015, www.censusindia.gov.in/pca/default.aspx Us-India Policy Institute. 2015. District Development and Diversity Index. Accessed July 2, 2015, http://www.usin- diapolicy.org/updates/general-news/225-district-development-and-diversity-index-report Finance Department, Government of Bihar. 2015. Economic Survey 2014-15. Accessed July 2, 2015, http://finance. bih.nic.in/Documents/Reports/Economic-Survey-2015-EN.pdf Government of India. 2014. State-wise Per Capita Income and Gross Domestic Product at current prices. Accessed July 2, 2015, http://pib.nic.in/archieve/others/2014/aug/d2014070801.pdf
  20. 20. IFPRI-NEW DELHI INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE NASC Complex, CG Block, Dev Prakash Shastri Road, Pusa, New Delhi 110012, India T+91.11.2584.6565 to 6567 F+91.11.2584.8008 CONTACT US: Email us at IFPRI-POSHAN@cgiar.org IFPRI-HEADQUARTERS INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE 2033 K Street, NW, Washington, DC 20006-1002 USA T. +1.202.862.5600  F. +1.202.467.4439  Skype: IFPRIhomeoffice  ifpri@cgiar.org  www.ifpri.org

×